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401 Grand St. Paterson, NJ 07505 | (973) 881-4000
"Rich History, Bright Future"

Nursing Home/Assisted Living Surveillance Form

Surveillance Date:


Name of Facility:


City:


County:
Passaic         Morris


Total Number of Residents:


Number with respiratory illness on surveillance date:


Please elaborate, if necessary, in comments below:


Reply Email Address: